Transfer of surgical competences in the treatment of intersex disorders in Togo.

BACKGROUND: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. MATERIALS AND METHODS: This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo. RESULTS: There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French-speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. CONCLUSION: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities.

Transfer of surgical competences in the treatment of intersex disorders in Togo

Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on intersex management; which was held from December 4 th to 8 th ; 2006; in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of ""Saint Jean de Dieu"" Hospital of Afagnan; Togo. Results: There were 107 participants [five professors of paediatric surgery; 62 African paediatric surgeons (including 15 from African French- speaking countries); and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding; recognising; and treating the sexual ambiguities); and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis; two of female pseudohermaphroditism; and two of male pseudohermaphroditism); were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. Conclusion: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities"

Epidemiological and pathological aspects of gastrointestinal tumors in Togo.

PURPOSE: The incidence of gastrointestinal tumors is difficult to estimate in Togo, so the purpose of this report was to describe the tumors diagnosed by the national pathology laboratory. METHODS: This was a retrospective descriptive study of 742 gastrointestinal tumors diagnosed between 1986 and 2005 by the pathology laboratory of the Tokoin university hospital in Lomé, Togo. RESULTS: There was an annual incidence of 37 gastrointestinal tumors, including 27 cancers, with twice as many tumors diagnosed in men as in women. The average age of patients diagnosed with a benign tumor was 44 years compared with 52 years for those with a malignant tumor. Stomach tumors predominated (n=306; 41.2%). Papilloma was the most frequent benign tumor type (n=100; 47.8%), while malignant tumors were mostly gastric adenocarcinoma (n=224; 42% of all cancers), esophageal squamous cell carcinoma (n=100; 19%) and colorectal adenocarcinoma (n=89; 17%). CONCLUSION: Gastrointestinal tumors are frequently seen in Togo, and an epidemiological monitoring program is needed.

Avulsion fractures of the tibial tubercle.

PURPOSE: To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. METHODS: Records of 12 patients aged 11 to 17 (mean, 14) years with avulsion fractures of the tibial tubercle presenting to our hospital from April 1998 to September 2004 were studied. Patient age, gender, involved side, injury mechanism, clinical and radiographic records, treatment, complications, and outcomes were reviewed. RESULTS: Eight patients injured the right side, 3 the left side, and one both sides. They all engaged in sports or active play during the injury. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. Three patients with type-I fractures and one with a type-IIB fracture were treated with closed reduction and cast immobilisation for 3 to 4 (mean, 3.8) weeks. The remaining 9 fractures were treated with open reduction and internal fixation. The mean follow-up period was 39 (range, 23-59) months. No complications were noted. Ten patients had excellent results and 2 had fair results. CONCLUSION: Closed reduction and cast immobilisation for minimally displaced fractures, and open reduction and internal fixation for displaced fractures resulted in favourable outcomes.

[Gastrointestinal lymphomas in Togo: epidemiological and prognosis aspects]. / Lymphomes gastro-intestinaux au Togo: aspects epidemiologiques et histopronostiques.

The digestive tract is the principal site of the extranodal non Hodgkin lymphomas. The purpose of our work was to describe the epidemiology and the prognosis of gastro-intestinal lymphomas in Togo. It was about a retrospective study relating to 32 cases diagnosed in Togo during 20 years. The gastro-intestinal lymphomas are not very frequent affection in Togo accounting for 5.6% of cancers of the digestive tract and occurring at 37 years an average age with a sex-ratio H/F to 1.5. Histologically, the lymphomas of intermediate rank were most observed according to the classification of Working Formulation (62.6%), where in fact the MALT lymphomas of high rank of malignity prevailed according to the classification of Isaacson. Their preferential topography was the stomach (59%). The narrowness of our technical plate poses enormous diagnostic problems of these lymphomas.

Lymphomes gastro-intestinaux au Togo : aspects epidemiologiques et histopronostiques

Le tube digestif est le site principal des lymphomes non hodgkinien extra ganglionnaires. Le but de notre travail etait de decrire l'epidemiologie et l'histopronostic des lymphomes gastro-intestinaux au Togo. Il s'est agi d'une etude retrospective portant sur 32 cas diagnostiques au Togo pendant 20 ans. Les lymphomes gastro-intestinaux constituent une affection peu frequente au Togo representant 5;6des cancers du tube digestif et survenant a un age moyen de 37 ans avec un sex-ratio H/F a 1;5. Au plan histologique; les lymphomes de grade intermediaire etaient les plus observes suivant la classification de la Working Formulation (62;6); alors que ce sont les lymphomes de MALT de haut grade de malignite qui predominaient suivant la classification d'Isaacson. Leur topographie preferentielle etait l'estomac (59des cas). L'etroitesse du plateau technique de notre Laboratoire d'Anatomie Pathologique pose d'enormes problemes diagnostiques de ces lymphomes

Musculoskeletal conditions in children attending two Togolese hospitals.

OBJECTIVE: A retrospective study was conducted in order to point out the different kinds of musculoskeletal conditions observed in children attending two Togolese hospitals. RESULTS: A total of 434 (242 females, 192 males) of the 29 620 children examined (1.5%) were suffering from these conditions. Probable joint and bone infections (187 patients, 43%), limb deformities (106 patients, 24%), osteochondrosis (60 patients, 14%) and vaso-occlusive crisis due to haemoglobinopathies (29 patients, 7%) were the main conditions observed. Osteomyelitis observed in 128 patients affected the humerus (25 patients), radius (10 patients), femur (68 patients), tibia (15 patients), fibula (five patients), and both tibia and fibula (five patients). Probably, infectious arthritis seen in 30 patients affected mainly the hip (11 patients) and the knee (13 patients). In the spine, infection affected the midthoracic and upper lumbar areas. Underdevelopment, sickle cell anaemia and sickle cell haemoglobin C disease were the main risk factors in determining susceptibility to infections. Vaso-occlusive crises were due to sickle cell anaemia (11 patients) and sickle cell haemoglobin C disease (18 patients). Osteochondrosis seen in 60 patients free from haemoglobinopathy involved the spine (Scheuermann's disease, 38 patients) and the hip (Legg-Calvé-Perthes disease, 22 patients). Limb deformities were observed in the knee (varus and valgus deformities in 64 patients) and the foot (talipes varus equin in 40 patients). CONCLUSION: This study's findings, which require further confirmation, suggest some conclusions. Scheuermann's disease can explain in part the degenerative disc conditions observed in African adults. Valgus and varus deformities play an important role in the development of knee osteoarthritis in Black Africa. An African child with joint or bone pain should be investigated for sickle cell anaemia. In the future, improved lifestyle and better health care will be essential to reduce bone and joint infections, and allow refined diagnosis of connective tissue diseases now probably underestimated in African children.

Cholecystites aigues alithiasiques d'origine typhique : a propos de 5 cas

L'etude rapporte les cas de cholecystite aigue alithiasique d'origine typhique operes chez les enfants au CHU de Lome-Tokoin; entre 1987 et 1994. La frequence de cette complication a ete de 0;6 pour cent. Elle a atteint 3 garcons et 2 filles; ages de 7 a 14 ans (moyenne a 8;6 ans). La symptomatologie fonctionnelle comportait dans 4 cas sur 5 une diarrhee febrile et dans tous les cas une douleur abdominale. L'examen physique a decele 2 fois une defense de l'hypochondre droit; et une fois une douleur provoquee de l'hypochondre droit. Tous les patients avaient un serodiagnostic de Widal positif. Le traitement a ete la cholecystectomie associee au traitement medical de la maladie causale. Les suites operatoires ont ete simples avec une mortalite nulle. Il faut savoir penser a cette complication dans un contexte evoquant la typhoide

Stenose hypertrophique du pylore du nourrisson au CHU de Lome (Togo)

Une etude prospective a permis en 4 ans (de janvier 1988 a decembre 1991) de recruter 19 cas de stenose hypertrophique du pylore chez le nourrisson au CHU de Lome (Togo). Les patients etaient ages de 28 a 80 jours; avec une predominance masculine (15 garcons pour 4 filles). Le diagnostic a ete essentiellement clinique; le motif d'hospitalisation univoque: les vomissements. Le diagnostic a ete confirme par une radiographie dans 13 cas; et une echographie a ete realisee chez 8 patients. Tous les patients ont ete traites par pylorotomie extramuqueuse par courte incision horizontale dans l'hypochondre droit. Au rang des complications observees la persistance postoperatoire des vomissements dans 8 cas. Aucun cas de blessure de la muqueuse duodenale; ni d'infection. Deux deces ont ete deplores. L'amelioration de nos resultats exige une specialisation de nos reanimateurs en reanimation neonatale